Article

Locally employed doctors (LEDs)

Information about locally employed doctors (LEDs), what the roles are, how they work and resources to support employers.

2 September 2024

A doctor on a hospital ward, making a phone call.

This article explains what these job roles are about, what that means for employers and resources to support their implementation.

Locally employed doctors (LEDs)

LED is a catch-all term used to refer to doctors employed by an NHS trust that are not on one of the nationally negotiated contracts.

Instead, LEDs are employed by a trust or provider on a local contract, which may and often will mirror one of those sets of terms and conditions of service (TCS) or might be a modified version.

For instance, only doctors in an approved national training post can be appointed onto the 2016 TCS for doctors and dentists in training, but doctors may be locally employed on TCS which mirror those.

LEDs can be found in any specialty and go by a range of titles including trust grade, trust doctor, clinical fellow, FY3, research fellow, and many others. LEDs play an essential role within the medical workforce.

They have diverse backgrounds and skills as well as a wide range of reasons for working in an LED role. Likewise, there are a range of reasons why employers might employ LED roles within their workforce.

Additionally, many LEDs are international medical graduates (IMGs) for whom an LED role may be their first experience working in the NHS.

LEDs play an important role in the medical workforce. Often, but not always at a level broadly equivalent to ST 1-3, many LEDs work alongside doctor in training (DiT) colleagues on rotas. LEDs may also work in undergraduate medical education and postgraduate fellow roles.
There are any many reasons for employers to employ doctors on local contracts, in particular when the terms of the national contracts might prohibit their use.
For instance, the 2016 doctor in training contract is explicitly only for those on an approved training programme. The 2021 specialty doctor contract has eligibility requirements that not all applicants may meet and, in particular where LEDs are working alongside DiTs, the session-based nature of this contract may cause conflict between working patterns.
The NHS Long Term Workforce Plan recognises the important role LEDs play and the rapid expansion of these roles within the workforce. It also sets out a commitment to better support their postgraduate career development.
As they are, by definition employed locally, there are no national terms and conditions for employers to use in creating contracts of employment for LEDs. Therefore, employers can create their own contracts of employment.
However, in most cases employers will use one of the national contracts as a basis for developing local contracts; most commonly the 2016 doctor in training TCS.
This would be the recommended approach where LEDs are working alongside doctors in training. We would advise employers as far as possible to use ESR Codes MT01-MT05 for LEDs employed on contracts parallel to the 2016 TCS. These codes are created specifically for LEDs on such contracts and ensures they are easily identifiable through ESR.
In addition, where employers make significant variations to contracts which move away from national terms and conditions, particularly in regard to pay, these may by default become local arrangements. In such cases parts of the national contracts, such as pay protection, may no longer apply.
When developing local contracts employers may wish to consider:
- access to study leave and study leave budget
- clinical supervision
- access to the guardian of safe working hours
- remuneration – particularly as relates to the 'going rate' assessments, which for doctors in training and those in parallel LED posts is generally matched by UKVI to the equivalent nodal point on the 2016 TCS.
While there are increasing numbers of UK graduates choosing LED roles as part of their career journey, it is also recognised that a large proportion of LEDs are IMGs.
A GMC paper in 2019 on SAS and LED roles showed that around two thirds of LEDs nationally initially graduated outside of the UK. For many, an LED role will be their first experience of working within the NHS.
As such, employers may wish to consider the additional support and resources these doctors may need when adapting to work and life within the UK. There are a number of resources available for employers and IMGs to support this:

LED FAQs

Find answers to popular questions and further information about locally employed doctors (LED).

As LED contracts are determined locally employers will need to determine pay scales for LEDs. For LEDs working alongside doctors in training, NHS Employers’ view is that the most appropriate pay is on Nodal Points 1-5, using ESR codes MT01-MT05. Some considerations employers will need to make when determining pay scales are: whether LEDs will be working in parallel to doctors on national grades, doing the same type of work. When and how to determine which pay point will be used (note that for doctors in training, nodal points are linked to progression through training). Meeting salary rate requirements for applications of Health and Care visas.
As LED contracts are determined locally employers will need to determine annual leave entitlement for LEDs. Employers may wish to consider the leave entitlements for doctors employed on the equivalent national contract (if any) to ensure parity between the grades.
Employers can set entitlement to study leave locally but should consider the importance of access to study leave in an LEDs ability to maintain and improve their clinical skills.
Exception reporting and the role of the guardian of safe working hours are ostensibly exclusive to those employed on the 2016 TCS. As such there is no automatic access to this process for LEDs. However an employer may wish to consider how the working hours of LEDs can be monitored and how they might raise and escalate any breaches of working hours regulations.
In many cases, in particular where LEDs work alongside DiTs, access to exception reporting and the Guardian may be the most appropriate course of action.
Employers are free to set the length of an LED contract themselves, there is no defined limit on length of contract. This may be affected by factors such as the length of the requirement, rotation intakes of doctors in training or any fixed term expansion of clinical areas.
Consideration should be given to IMGs and the difficulties in obtaining right to live and work when employed on a short-term basis.
Employers may offer permanent LED contracts should they choose to do so, but may wish to consider offering one of the national career grade contracts (such as specialty doctor) where this is appropriate.

Read our case study with University Hospital Birmingham (UHB) to find out how investment in its LED workforce has improved patient safety and reduced locum costs.

Improving the experience of LEDs case study.

Read our case study Manchester University NHS Foundation Trust (MFT) to find out how investment in its LED workforce has improved the recruitment and retention.

Supporting the retention of locally employed doctors.

We would love to hear from you about employment of LEDs.

If you would like to share local practices or discuss this topic in more detail please contact the medical workforce team.

Locally employed doctors (LEDs)

Locally employed doctors (LEDs)

LED FAQs

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